Sagittal Split Ramus Osteotomy in the Shortest Buccal Bone Marrow Distances of the Mandible on the Coronal Plane.

Chun-Ming Chen,Shih-Wei Liang,I-Ling Lin,Han-Jen Hsu,Ping-Ho Chen,Kun-Jung Hsu,Vincenzo Iorio Siciliano

doi:10.1155/2021/5586498

Abstract

Purpose This study investigated the relationship between the shortest buccal bone marrow of the ramus and skeletal patterns. Materials and Methods Using cone-beam computed tomography data (specifically, the A point-nasion-B point (ANB) angle), we divided patients into three groups as follows: skeletal class I (0° < ANB < 4°), class II (ANB: ≥4°), and class III (ANB: ≤0°). Sixteen vertical sections in the coronal plane were taken starting from slice 0 (original intact mandibular canal) anteriorly at 2 mm intervals to slice 15 (30 mm). The thickness of the mandible (M) and shortest buccal bone marrow (SBM) were measured. The data of SBM were divided into two groups (SBM ≥ 1 mm and SBM < 1 mm). For each skeletal pattern, an SBM value < 1 mm was considered to indicate a high possibility of postoperative nerve paresthesia and bad split. Results The three skeletal pattern groups also did not significantly differ in their M values for all sections. The mean SBM values of class III (0.91–2.11 mm) at 6–16 mm anterior to the mandibular foramen were significantly smaller than those of class II (1.53–3.17 mm). Comparing the occurrence ratio of SBM < 1 mm, the highest and lowest probabilities in class III (55% and 21.7%, respectively) were significantly larger at 6–20 mm anterior to the mandibular foramen than those in class II (28.3% and 5%, respectively). Conclusion Class III had a significantly shorter SBM distance and higher SBM occurrence probability than class II at the mandibular ramus region, implying that class III participants are more likely than class II participants to have nerve paresthesia and bad split after sagittal split ramus osteotomy.

Highlights

Malocclusion is frequently accompanied by facial deformities, which considerably affects respiration, eating, and speech and social interaction
The osteotomy incision is made through the cortex into the buccal bone marrow, and the osteotomes are inserted into the marrow to engage the lower border of the mandible, followed by mandibular splitting
Analysis of variance was used to determine if the skeletal pattern groups differed in their anatomical structures in the buccal-lingual direction of the mandibular canal

Summary

Introduction

Malocclusion is frequently accompanied by facial deformities, which considerably affects respiration, eating, and speech and social interaction. Facial deformities have a significant negative effect on perceptions of social functionality, including employability, honesty, and trustworthiness [1]. Sagittal split ramus osteotomy (SSRO) is commonly used to correct mandibular protrusion, retrusion, and asymmetry. Its advantages include enhanced bone healing because of larger overlapping segments, better and easier postoperative airway management, immediate postoperative jaw mobilization, leading to better oral hygiene and quicker improvement to a regular diet, and better speech and social activity [2]. The sagittal osteotomy line of SSRO starts at the buccal cortex of the mandibular ramus and body. The osteotomy incision is made through the cortex into the buccal bone marrow, and the osteotomes are inserted into the marrow to engage the lower border of the mandible, followed by mandibular splitting. Many researchers [3,4,5,6] have reported the postoperative complications of SSRO, especially

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